The proposed study addresses NINR's mission of eliminating health disparities due to geographic location. Rural hospitals are absent from existing studies that identify community factors (i.e. level of poverty) and organizational factors (i.e. the nurse work environment and hospital characteristics) that influence quality of care and clinical outcomes. In this proposed K01, structural contingency theory is used to conceptualize the association between the nurse work environment, rural community characteristics, hospital and nursing unit characteristics, quality of care, and clinical outcomes (Ml mortality). The goals of this proposed mentored research are to: a) develop a nurse assessed quality indicator and test this measure against established quality indicators (hospital collected, and large public data sets);b) evaluate the relationship between quality indicators and clinical outcomes in small rural hospitals;c) examine characteristics of the community, hospital, nursing unit, and nurse work environment that may influence quality of care indicators and Ml mortality in small rural hospitals. To accomplish this, the candidate will pursue a career development program, and will gain knowledge and proficiency in designing, developing, and using Web surveys;using large secondary public data bases;negotiating the special challenges that rural health research poses;and acquiring advanced knowledge of statistical methods and computer applications needed to do large scale studies using multilevel data. The candidate will be prepared to assume a lead role in planning and conducting complex rural nursing health studies. The training will be applied to the proposed study where small rural hospitals in two states will be invited to participate through their chief nursing officer. Data will be collected from multiple sources: Web-based staff nurse surveys, hospital administrative data, and large public data bases (i.e. Hospital Compare and state discharge data). The data will be analyzed using multilevel modeling and regression techniques. This study will form the basis for future research that includes an expansion of quality of care in the hospital to patient's quality of life after discharge. Findings from this study may inform administrators and policy makers on how quality of care and Ml mortality rates for patients in small rural hospitals are influenced by factors in the nurses'work environment as well as characteristics of the rural community, hospital, and nursing unit.